Methods of treating hormone-related conditions using thio-oxindole derivatives

ABSTRACT

The present invention provides methods of inducing contraception which includes delivering to a female a composition containing a compound of formula I, or tautomers thereof, in a regimen which involves delivering one or more of a selective estrogen receptor modulator, wherein formula I is: 
                         
and wherein R 1 -R 5  and Q 1  are defined as described herein. Methods of providing hormone replacement therapy and for treating carcinomas, dysfunctional bleeding, uterine leiomyomata, endometriosis, and polycystic ovary syndrome is provided which includes delivering a compound of formula I and a selective estrogen receptor modulator are also described.

CROSS-REFERENCE TO RELATED APPLICATION

This is divisional of U.S. patent application Ser. No. 10/601,438, filedJun. 23, 2003, which claims the benefit of the priority of U.S. PatentApplication No. 60/391,826, filed Jun. 25, 2002, now expired. Thesepriority applications are herein incorporated by reference.

BACKGROUND OF THE INVENTION

This invention relates generally to the treatment of hormone-relatedconditions using compositions containing small molecules.

A number of successful treatments have been found in the treatment ofhormone related conditions and include the delivery of natural andsynthetic hormones. Specifically, estrogen has been utilized for itspositive effects including the maintenance of bone density, centralnervous system (CNS) function, and the protection of organ systems fromthe effects of aging. However, the delivery of estrogen also hasimportant disadvantages including an increase in the risk of cancers.

There exists a continued need in the art for alternative methods ofalleviating the symptoms and/or resolving a variety of hormone relatedconditions.

SUMMARY OF THE INVENTION

In one aspect, a method of inducing contraception is provided whichincludes delivering a compound of formula I and a selective estrogenreceptor modulator, wherein formula I is:

In another aspect, a method of providing hormone replacement therapy isprovided which includes delivering a compound of formula I and aselective estrogen receptor modulator.

In a further aspect, methods of treating carcinomas, dysfunctionalbleeding, uterine leiomyomata, endometriosis, and polycystic ovarysyndrome is provided which includes delivering a compound of formula Iand a selective estrogen receptor modulator.

Other aspects and advantages of the present invention are describedfurther in the following detailed description of the preferredembodiments thereof.

DETAILED DESCRIPTION OF THE INVENTION

The present invention provides methods of treating hormone relatedconditions including delivering to a mammal a composition comprising acompound of formula I in a regimen which includes delivering apharmaceutically effective amount of one or more of a selective estrogenreceptor modulator to the mammal.

Preferably, the mammalian patient treated according to the presentinvention is a human, and more preferably a female. When used forinducing contraception, the mammalian patient is a female ofchild-bearing age. Further, when used for providing hormone replacementtherapy, the mammalian patient is preferably a pre-menopausal,menopausal, or post-menopausal female.

The term “selective estrogen receptor modulator” or “SERM” is meant todescribe a compound that exhibits activity as an agonist or antagonistof an estrogen receptor in a tissue-dependent manner. SERMs can act asestrogen receptor agonists in some tissues and as antagonists in othertissue types. The term SERMs can also be interchanged with the term“anti-estrogen”.

The term estrogen is mean to describe any estrogenic agent. Preferably,the estrogenic agent is a conjugated equine estrogen.

A number of hormone-related conditions can be treated according to themethods of the present invention. Preferably, estrogen-relatedconditions are treated using the compositions of the present invention.Such estrogen related conditions can include, without limitation, theinduction of contraception, providing hormone replacement therapy, thetreatment of obesity, carcinomas, osteoporosis, endometriosis,menopausal syndromes (including perimenopausal, menopausal, orpostmenopausal syndromes), hair loss (alopecia), diabetes, Alzheimer'sDisease, urinary incontinence, arthritis, gastrointestinal (GI) tractconditions, acne, cataracts, hirsutism, polycystic ovary syndrome,uterine leiomyomata, multiple myeloma, dysfunctional bleeding, lymphoma,dysmennorhea, and the stimulation of food intake. Examples of carcinomasthat can be treated according to the present invention include breast,prostate, colon, lung, ovarian, melanoma, central nervous system (CNS),cervical, uterine, endometrial, and renal carcinomas.

The present invention provides methods of inducing contraceptionincluding the step of delivering to a female of child-bearing age acomposition comprising a compound of formula I in a regimen whichinvolves delivering a pharmaceutically effective amount of one or moreof a selective estrogen receptor modulator to the female.

Also provided are methods for providing hormone replacement therapyincluding the step of delivering to a female a composition comprising acompound of formula I in a regimen which involves delivering apharmaceutically effective amount of one or more of a selective estrogenreceptor modulator to the female. Such therapy can be performed duringmenopause, or pre- or post-menopause.

The present invention further provides methods for treating carcinomasincluding the step of delivering to a mammal in need thereof acomposition comprising a compound of formula I in a regimen whichinvolves delivering a pharmaceutically effective amount of one or moreof a selective estrogen receptor modulator to the mammal.

Additionally provided are methods for treating dysfunctional bleeding,uterine leiomyomata, endometriosis, or polycystic ovary syndrome,including the step of delivering to a female in need thereof acomposition comprising a compound of formula I in a regimen whichinvolves delivering a pharmaceutically effective amount of one or moreof a selective estrogen receptor modulator to the female.

I. Compositions Useful in the Methods of the Invention

In one embodiment, the methods of the present invention include thedelivery of compounds of formula I, the preparation of which isdescribed in U.S. Pat. No. 6,355,648 and International PatentPublication No. WO 00/66555, and hereby incorporated by reference.Suitably, these compounds are progesterone-receptor (PR) modulators,which, when used in the methods of the invention, are delivered as a PRagonist. The compounds of formula I have the structure:

wherein:

R¹ and R² are selected from the group consisting of H, alkyl,substituted alkyl, OH, O(alkyl), O(substituted alkyl), O(Acetyl), aryl,substituted aryl, heterocyclic ring, substituted heterocyclic ring,alkylaryl, substituted alkylaryl, alkylheteroaryl, substitutedalkylheteroaryl, 1-propynyl, substituted 1-propynyl, 3-propynyl, andsubstituted 3-propynyl;

or R¹ and R² are joined to form a ring selected from the groupconsisting of —CH₂(CH₂)_(n)CH₂—, —CH₂CH₂C(CH₃)₂CH₂CH₂—, —O(CH₂)_(m)CH₂—,—O(CH₂)_(p)O—, —CH₂CH₂OCH₂CH₂—, —CH₂CH₂N(H)CH₂CH₂—, and—CH₂CH₂N(alkyl)CH₂CH₂—;

m is an integer from 1 to 4;

n is an integer from 1 to 5;

p is an integer from 1 to 4;

or R¹ and R² form a double bond to C(CH₃)₂, C(cycloalkyl), O, orC(cycloether);

R³ is selected from the group consisting of H, OH, NH₂, C₁ to C₆ alkyl,substituted C₁ to C₆ alkyl, C₃ to C₆ alkenyl, substituted C₃ to C₆alkenyl, alkynyl, substituted alkynyl, and COR^(A);

R^(A) is selected from the group consisting of H, C₁ to C₃ alkyl,substituted C₁ to C₃ alkyl, C₁ to C₃ alkoxy, substituted C₁ to C₃alkoxy, C₁ to C₃ aminoalkyl, and substituted C₁ to C₃ aminoalkyl;

R⁴ is selected from the group consisting of H, halogen, CN, NH₂, C₁ toC₆ alkyl, substituted C₁ to C₆ alkyl, C₁ to C₆ alkoxy, substituted C₁ toC₆ alkoxy, C₁ to C₆ aminoalkyl, and substituted C₁ to C₆ aminoalkyl;

R⁵ is selected from the group consisting of a), b) and c):

a) a substituted benzene ring having the structure:

-   -   X is selected from the group consisting of halogen, OH, CN, C₁        to C₃ alkyl, substituted C₁ to C₃ alkyl, C₁ to C₃ alkoxy,        substituted C₁ to C₃ alkoxy, C₁ to C₃ thioalkyl, substituted C₁        to C₃ thioalkyl, S(O)alkyl, S(O)₂alkyl, C₁ to C₃ aminoalkyl,        substituted C₁ to C₃ aminoalkyl, NO₂, C₁ to C₃ perfluoroalkyl,        substituted C₁ to C₃ perfluoroalkyl, 5 or 6 membered        heterocyclic ring comprising 1 to 3 heteroatoms, CONH₂, CSNH₂,        CNHNHOH, CNH₂NOH, CNHNOH, COR^(B), CSR^(B), OCOR^(B), and        NR^(C)COR^(B);    -   R^(B) is selected from the group consisting of H, C₁ to C₃        alkyl, substituted C₁ to C₃ alkyl, aryl, substituted aryl, C₁ to        C₃ alkoxy, substituted C₁ to C₃ alkoxy, C₁ to C₃ aminoalkyl, and        substituted C₁ to C₃ aminoalkyl;    -   R^(C) is H, C₁ to C₃ alkyl, or substituted C₁ to C₃ alkyl;    -   Y and Z are independently selected from the group consisting of        H, halogen, CN, NO₂, C₁ to C₃ alkoxy, substituted C₁ to C₃        alkoxy, C₁ to C₄ alkyl, substituted C₁ to C₄ alkyl, C₁ to C₃        thioalkyl, and substituted C₁ to C₃ thioalkyl;

b) a five or six membered heterocyclic ring comprising 1, 2, or 3heteroatoms selected from the group consisting of O, S, SO, SO₂ and NR⁶and having one or two independent substituents from the group consistingof H, halogen, CN, NO₂, C₁ to C₄ alkyl, substituted C₁ to C₄ alkyl, C₁to C₃ alkoxy, substituted C₁ to C₃ alkoxy, C₁ to C₃ aminoalkyl,substituted C₁ to C₃ aminoalkyl, COR^(D), CSR^(D), and NR^(E)COR^(D);

-   -   R^(D) is H, NH₂, C₁ to C₃ alkyl, substituted C₁ to C₃ alkyl,        aryl, substituted aryl, C₁ to C₃ alkoxy, substituted C₁ to C₃        alkoxy, C₁ to C₃ aminoalkyl, or substituted C₁ to C₃ aminoalkyl;    -   R^(E) is H, C₁ to C₃ alkyl, or substituted C₁ to C₃ alkyl;    -   R⁶ is H, C₁ to C₃ alkyl, substituted C₁ to C₃ alkyl, or C₁ to        C₄CO₂alkyl;        or

c) an indol-4-yl, indol-7-yl or benzo-2-thiophene moiety, wherein saidmoiety is optionally substituted by from 1 to 3 substituents selectedfrom the group consisting of halogen, alkyl, substituted alkyl, CN, NO₂,alkoxy, substituted alkoxy, and CF₃;

Q¹ is S, NR⁷, or CR⁸R⁹;

R⁷ is selected from the group consisting of CN, C₁ to C₆ alkyl,substituted C₁ to C₆ alkyl, C₃ to C₈ cycloalkyl, substituted C₃ to C₈cycloalkyl, aryl, substituted aryl, heterocyclic ring, substitutedheterocyclic ring, acyl, substituted acyl, aroyl, substituted aroyl,SO₂CF₃, OR¹¹, and NR¹¹R¹²;

R⁸ and R⁹ are independent substituents selected from the groupconsisting of H, alkyl, substituted alkyl, acyl, substituted acyl,aroyl, substituted aroyl, C₃ to C₈ cycloalkyl, substituted C₃ to C₈cycloalkyl, aryl, substituted aryl, heterocyclic ring, substitutedheterocyclic ring, NO₂, CN, and CO₂R¹⁰;

R¹⁰ is C₁ to C₃ alkyl or substituted C₁ to C₃ alkyl;

or CR⁸R⁹ comprise a six membered ring having the structure:

R¹¹ and R¹² are independently selected from the group consisting of H,alkyl, substituted alkyl, aryl, substituted aryl, heterocyclic ring,substituted heterocyclic ring, acyl, substituted acyl, aroyl,substituted aroyl, sulfonyl, and substituted sulfonyl; or apharmaceutically acceptable salt, tautomer, metabolite, or prodrugthereof.

In some embodiments, R⁸ and R⁹ are selected from among substituted orunsubstituted C₁-C₆ alkyls.

In one embodiment, in the compound of formula I:

R¹ and R² are alkyl or substituted alkyl; R³ is H; R¹¹ and R¹² areindependently selected from the group consisting of H, alkyl,substituted alkyl, aryl, substituted aryl, heterocyclic ring,substituted heterocyclic ring, acyl, substituted acyl, aroyl,substituted aroyl, sulfonyl, and substituted sulfonyl; the othersubstituents are as defined above, and a pharmaceutically acceptablesalt, tautomer, metabolite, or prodrug thereof.

In another embodiment, in compound of formula I:

R¹ and R² are joined to form a ring selected from the group consistingof —CH₂(CH₂)_(n)CH₂, —CH₂CH₂C(CH₃)₂CH₂CH₂—, O(CH₂)_(m)CH₂—,—O(CH₂)_(p)O—, —CH₂CH₂OCH₂CH₂—, —CH₂CH₂N(H)CH₂CH₂—, and—CH₂CH₂N(alkyl)CH₂CH₂—. In some embodiments, the ring has the structure

In one embodiment of the compound of formula I, when R¹ and R² arejoined to form a ring, R³ is H; R⁸ and R⁹ are independent substituentsselected from the group consisting of H, C₁ to C₆ alkyl, substituted C₁to C₆ alkyl, C₃ to C₈ cycloalkyl, substituted C₃ to C₈ cycloalkyl, aryl,substituted aryl, heterocyclic ring, substituted heterocyclic ring, NO₂,CN, and CO₂R¹⁰; and the other substituents are as defined above; or apharmaceutically acceptable salt, tautomer, metabolite, or prodrugthereof.

In a further embodiment, in the compound of formula I, R³ is H; Q¹ is Sor NR⁷; R⁷ is selected from the group consisting of CN, C₁ to C₆ alkyl,substituted C₁ to C₆ alkyl, C₃ to C₈ cycloalkyl, substituted C₃ to C₈cycloalkyl, aryl, substituted aryl, heterocyclic ring, substitutedheterocyclic ring, acyl, substituted acyl, aroyl, substituted aroyl,SO₂CF₃, OR¹¹ and NR¹¹R¹²; R¹¹ and R¹² are independently selected fromthe group consisting of H, alkyl, substituted alkyl, aryl, substitutedaryl, heterocyclic ring, substituted heterocyclic ring, acyl,substituted acyl, aroyl, substituted aroyl, sulfonyl, and substitutedsulfonyl; or a pharmaceutically acceptable salt, tautomer, metabolite,or prodrug thereof.

In a further embodiment the compound is of formula II:

wherein:

R¹¹ is selected from the group consisting of H, acyl, substituted acyl,aroyl, substituted aroyl, sulfonyl, and substituted sulfonyl;

R⁵ is (i), (ii), or (iii):

(i) a substituted benzene ring having the structure:

wherein:

-   -   X is selected from the group consisting of halogen, CN, CONH₂,        CSNH₂, CONHalkyl, CSNHalkyl, CON(alkyl)₂, CSN(alkyl)₂, CNHNHOH,        CNH₂NOH, C₁ to C₃ alkoxy, C₁ to C₃ alkyl, NO₂, C to C₃        perfluoroalkyl, 5 membered heterocyclic ring comprising 1 to 3        heteroatoms, and C₁ to C₃ thioalkyl;    -   Y is selected from the group consisting of H, halogen, CN, NO₂,        C₁ to C₃ alkoxy, C₁ to C₄ alkyl, and C₁ to C₃ thioalkyl;

(ii) a five membered ring having the structure:

wherein:

-   -   U is O, S, or NR⁶;    -   R⁶ is H, C₁ to C₃ alkyl, or C₁ to C₄ CO₂alkyl;    -   X′ is selected from the group consisting of halogen, CN, NO₂,        CONH₂, CNHNHOH, CNH₂NOH, CSNH₂, CONHalkyl, CSNHalkyl,        CON(alkyl)₂, CSN(alkyl)₂, C₁ to C₃ alkyl, and C₁ to C₃ alkoxy;    -   Y′ is selected from the group consisting of H, F, and C₁ to C₄        alkyl; or    -   (iii) a six membered ring having the structure:

wherein:

-   -   X¹ is N or CX²;    -   X² is halogen, CN, CONH₂, CSNH₂, CONHalkyl, CSNHalkyl,        CON(alkyl)₂, CSN(alkyl)₂ or NO₂;        or a pharmaceutically acceptable salt, tautomer, metabolite, or        prodrug thereof. Preferably, R⁵ is the five membered ring (ii)        and U is O or S.

In yet another embodiment, the compound is of formula III:

wherein:

R⁵ is (i), (ii), or (iii):

(i) a substituted benzene ring having the structure:

wherein:

-   -   X is selected from the group consisting of halogen, CN, CONH₂,        CSNH₂, CONHalkyl, CSNHalkyl, CON(alkyl)₂, CSN(alkyl)₂, CNHNOH,        C₁ to C₃ alkoxy, C₁ to C₃ alkyl, NO₂, C₁ to C₃ perfluoroalkyl, 5        membered heterocyclic ring comprising 1 to 3 heteroatoms, and C₁        to C₃ thioalkyl;    -   Y is selected from the group consisting of H, halogen, CN, NO₂,        C₁ to C₃ alkoxy, C₁ to C₄ alkyl, and C₁ to C₃ thioalkyl;

(ii) a five membered ring having the structure:

wherein:

-   -   U is O, S, or NR⁶;    -   R⁶ is H, C₁ to C₃ alkyl, or C₁ to C₄ CO₂alkyl;    -   X′ is selected from the group consisting of halogen, CN, NO₂,        CONH₂, CSNH₂, CONHalkyl, CSNHalkyl, CON(alkyl)₂, CSN(alkyl)₂, C₁        to C₃ alkyl, and C₁ to C₃ alkoxy;    -   Y′ is selected from the group consisting of H, F and C₁ to C₄        alkyl; or

(iii) a six membered ring having the structure:

wherein:

-   -   X¹ is N or CX²;    -   X² is halogen, CN, CONH₂, CSNH₂, CONHalkyl, CSNHalkyl,        CON(alkyl)₂, CSN(alkyl)₂ or NO₂;        or a pharmaceutically acceptable salt, tautomer, metabolite, or        prodrug thereof. Preferably, R⁵ is the five membered ring (ii)        and U is O or S.

In a further embodiment, the compound is of formula IV:

wherein:

R⁸ is selected from the group consisting of H, CO₂R¹⁰, acyl, substitutedacyl, aroyl, substituted aroyl, alkyl, substituted alkyl, and CN;

R¹⁰ is C₁ to C₃ alkyl;

R⁵ is (i), (ii), or (iii):

(i) a substituted benzene ring having the structure:

wherein:

-   -   X is selected from the group consisting of halogen, CN, CONH₂,        CSNH₂, CONHalkyl, CSNHalkyl, CON(alkyl)₂, CSN(alkyl)₂, CNHNOH,        C₁ to C₃ alkoxy, C₁ to C₃ alkyl, NO₂, C₁ to C₃ perfluoroalkyl, 5        membered heterocyclic ring comprising 1 to 3 heteroatoms, and C₁        to C₃ thioalkyl;    -   Y is selected from the group consisting of H, halogen, CN, NO₂,        C₁ to C₃ alkoxy, C₁ to C₄ alkyl, and C₁ to C₃ thioalkyl;

(ii) a five membered ring having the structure:

wherein:

-   -   U is O, S, or NR⁶;    -   R⁶ is H, C₁ to C₃ alkyl, or C₁ to C₄ CO₂alkyl;    -   X′ is selected from the group consisting of halogen, CN, NO₂,        CONH₂, CSNH₂, CONHalkyl, CSNHalkyl, CON(alkyl)₂, CSN(alkyl)₂, C₁        to C₃ alkyl, and C₁ to C₃ alkoxy;    -   Y′ is selected from the group consisting of H, F and C₁ to C₄        alkyl;

(iii) a six membered ring having the structure:

wherein:

-   -   X¹ is N or CX²;    -   X² is halogen, CN, CONH₂, CSNH₁₂, CONHalkyl, CSNHalkyl,        CON(alkyl)₂, CSN(alkyl)₂ or NO₂;        or a pharmaceutically acceptable salt, tautomer, metabolite, or        prodrug thereof.        Preferably, R⁵ is the five-membered ring (ii) and U is O or S.

In another embodiment, the compound is of formula V:

R⁵ is (i), (ii), or (iii):

(i) a substituted benzene ring having the structure:

wherein:

-   -   X is selected from the group consisting of halogen, CN, CONH₂,        CSNH₂, CONHalkyl, CSNHalkyl, CON(alkyl)₂, CSN(alkyl)₂, CNHNOH,        C₁ to C₃ alkoxy, C₁ to C₃ alkyl, NO₂, C₁ to C₃ perfluoroalkyl, 5        membered heterocyclic ring comprising 1 to 3 heteroatoms, and C₁        to C₃ thioalkyl;    -   Y is selected from the group consisting of H, halogen, CN, NO₂,        C₁ to C₃ alkoxy, C₁ to C₄ alkyl, and C₁ to C₃ thioalkyl;

(ii) a five membered ring having the structure:

wherein:

-   -   U is O, S, or NR⁶;    -   R⁶ is H, C₁ to C₃ alkyl, or C₁ to C₄ CO₂alkyl;    -   X′ is selected from the group consisting of halogen, CN, NO₂,        CONH₂, CSNH₂, CONHalkyl, CSNHalkyl, CON(alkyl)₂, CSN(alkyl)₂, C₁        to C₃ alkyl, and C₁ to C₃ alkoxy;    -   Y′ is selected from the group consisting of H, F, and C₁ to C₄        alkyl;

(iii) a six membered ring having the structure:

wherein:

-   -   X¹ is N or CX²;    -   X² is halogen, CN, CONH₂, CSNH₂, CONHalkyl, CSNHalkyl,        CON(alkyl)₂, CSN(alkyl)₂ or NO₂;

or a pharmaceutically acceptable salt, tautomer, metabolite, or prodrugthereof. Preferably, R⁵ is the five membered ring (ii) and U is O or S.

In yet another embodiment, the compound is selected from the groupconsisting of5′-(3-Chlorophenyl)spiro[cyclohexane-1,3′-[3H]indol]-2′(1′H)-thione,3-(1′,2′-Dihydro-2′-thioxospiro[cyclohexane-1,3′-[3H]indol]-5′-yl)benzonitrile,4-(1′,2′-Dihydro-2′-thioxospiro[cyclohexane-1,3′-[3H]indol]-5′-yl)-2-thiophenecarbonitrile,3-(1,2-Dihydro-2-thioxospiro[cyclohexane-1,3-[3H]indol]-5-yl)-5-fluorobenzonitrile,4-Methyl-5-(1,2-dihydro-2-thioxospiro[cyclohexane-1,3-[3H]-indol]-5-yl)-2-thiophenethioamide,5-(1,2-Dihydro-2-thioxospiro[cyclopentane-1,3-[3H]indol]-5′-yl)-1H-pyrrole-2-carbonitrile,5-(1,2-Dihydro-2-thioxospiro[cyclohexane-1,3-[3H]indol]-5-yl)-1-(tert-butoxycarbonyl)-pyrrole-2-carbonitrile,5-(1,2-Dihydro-2-thioxospiro[cyclohexane-1,3-[3H]indol]-5-yl)-1-H-pyrrole-2-carbonitrile,5-(2′-thioxospiro[cyclohexane-1,3′-[3H]indol]-5′-yl)-1-methyl-pyrrole-2-carbonitrile,5-(1,2-Dihydro-2-thioxospiro[cyclopentane-1,3-[3H]indol]-5-yl)-3-thiophenecarbonitrile,5-(1,2-Dihydro-thioxospiro[cyclopentane-1,3-[3H]indol]-5-yl)-2-thiophenecarbonitrile,5-(3-Fluoro-4-methoxyphenyl)spiro[cyclohexane-1,3-[3H]indol]-2(1H)-thione,5-(2-Amino-5-pyrimidinyl)spiro[cyclohexane-1,3-[3H]indol]-2(1H)-thione,3-(1,2-Dihydro-2-thioxospiro[cyclopentane-1,3-[3H]indol]-5-yl)-5-fluorobenzonitrile,5-(3-chlorophenyl)-3,3-dimethyl-1,3-dihydro-2H-indole-2-thione,3-Benzyl-5-(3-chlorophenyl)-3-methyl-1,3-dihydro-2H-indole-2-thione,4-(3,3-dimethyl-2-thioxo-2,3-dihydro-1H-indol-5-yl)-2-furonitrile,5-(3-methoxyphenyl)-3,3-dimethyl-1,3-dihydro-2H-indole-2-thione,3-(1,2-Dihydro-2-thioxospiro[cyclohexane-1,3-[3H]indol]-5-yl)-4-fluorobenzonitrile,5-(1,2-Dihydro-2-thioxospiro[cyclohexane-1,3-[3H]indol]-5-yl)-3-pyridinecarbonitrile,5-(3,4-Difluorophenyl)spiro[cyclohexane-1,3-[3H]indol]-2(1H)-thione,5-(5-Chloro-2-thienyl)spiro[cyclohexane-1,3-[3H]indol]-2(1H)-thione,5-(1,2-Dihydro-2-thioxospiro[cyclohexane-1,3-[3H]indol]-5-yl)-3-furancarbonitrile,5-(3-Chloro-4-fluorophenyl)spiro[cyclohexane-1,3-[3H]indol]-2(1H)-thione,5-(3-Chloro-5-fluorophenyl)spiro[cyclohexane-1,3-[3H]indol]-2(1H)-thione,5-(3,5-Difluorophenyl)spiro[cyclohexane-1,3-[3H]indol]-2(1H)-thione,5-(1,2-Dihydro-2-thioxospiro[cyclohexane-1,3-[3H]indol]-5-yl)-4-propyl-2-thiophenecarbonitrile,5-(3-Fluoro-4-nitrophenyl)spiro[cyclohexane-1,3-[3H]indol]-2(1H)-thione,4-(1,2-Dihydro-2-thioxospiro[cyclohexane-1,3-[3H]indol]-5-yl)-2-furancarbonitrile,5″-(3-Chlorophenyl)spiro[cyclobutane-1,3″-[3H]indol]-2″(1″H)-thione,5″-(2-Chlorophenyl)spiro[cyclohexane-1,3″-[3H]indol]-2″(1″H)-thione,5″-(4-Chlorophenyl)spiro[cyclohexane-1,3″-[3H]indol]-2″(1″H)-thione,5-(1″,2″-Dihydro-2″-thioxospiro[cyclohexane-1,3″-[3H]indol]-5″-yl)-4-methyl-2-thiophenecarbonitrile,5-(1″,2″-Dihydro-2″-thioxospiro[cyclohexane-1,3″-[3H]indol]-5″-yl)-2-thiophenecarbonitrile,5″-(3-Fluorophenyl)spiro[cyclohexane-1,3″-[3H]indol]-2″ (1″H)-thione,5-(3-Hydroxyphenyl)spiro[cyclohexane-1,3-[3H]indol]-2(1H)-thione,5-(3-chlorophenyl)-3,3-diethyl-1,3-dihydro-2H-indole-2-thione,5-(4-Fluoro-3-(trifluoromethyl)phenyl)spiro[cyclohexane-1,3-[3H]indol]-2(1H)-thione,4-(1,2-Dihydro-2-thioxospiro[cyclohexane-1,3-[3H]indol]-5-yl)-2-fluorobenzonitrile,5-(1,2-Dihydro-2-thioxospiro[cyclohexane-1,3-[3H]indol]-5-yl)-4-n-butyl-2-thiophenecarbonitrile,5-(3-Fluoro-5-methoxyphenyl)spiro[cyclohexane-1,3-[3H]indol]-2(1H)-thione,5-(3-Chlorophenyl)-N-hydroxyspiro[cyclohexane-1,3′-[3H]indol]-2-amine,N-(Acetyloxy)-5′-(3-chlorophenyl)spiro[cyclohexane-1,3′-[3H]indol]-2″amine,5′-(3-Fluorophenyl)spiro[cyclohexane-1,3′-[3H]indol]-2′(1′H)-one oxime,5′-(2-Fluorophenyl)spiro[cyclohexane-1,3′-[3H]indol]-2′(1′H)-one oxime,5′-(4-Fluorophenyl)spiro[cyclohexane-1,3′-[3H]indol]-2′(1′H)-one oxime,5′-(3,4-difluorophenyl)spiro[cyclohexane-1,3′-[3H]indol]-2′(1′H)-oneoxime, 5′-(3-methoxyphenyl)spiro[cyclohexane-1,3′-[3H]indol]-2′(1′H)-oneoxime, 5′-(3-nitrophenyl)spiro[cyclohexane-1,3′-[3H]indol]-2′(1′H)-oneoxime, 5′-(3-cyanophenyl)spiro[cyclohexane-1,3′-[3H]indol]-2′(1′H)-oneoxime,3-(1′,2′-Dihydro-2′-(hydroxyimino)spiro[cyclohexane-1,3′-[3H]indol]-5′-yl)-5-fluorobenzonitrile,5-(Spiro[cyclohexane-1,3′-[3H]indol]-2′-(hydroxyimino)-5′-yl)-4-methyl-2-thiophenecarbonitrile,5-(Spiro[cyclohexane-1,3′-[3H]indol]-2′-(hydroxyimino)-5′-yl)-2-thiophenecarbonitrile,4-(Spiro[cyclohexane-1,3′-[3H]indol]-2′-(hydroxyimino)-5′-yl)-2-thiophenecarbonitrile,5-(Spiro[cyclohexane-1,3′-[3H]indol]-2′-(hydroxyimino)-5′-yl)-1H-pyrrole-1-methyl-2-carbonitrile,5-(spiro[cyclohexane-1,3′-[3H]indol]-2′-(hydroxyimino)-5′-yl)-1H-pyrrole-2-carbonitrile,4-(Spiro[cyclohexane-1,3′-[3H]indol]-2′(acetoxyimino)-5′-yl)-2-thiophenecarbonitrile,3-Fluoro-N′-hydroxy-5-(2′-(hydroxyamino)spiro[cyclohexane-1,3′-[3H]indol]-5′-yl)benzenecarboximidamide,N′-Hydroxy-5-(spiro[cyclohexane-1,3′-[3H]indol]-2′-(hydroxyimino)-5′-yl)-4-methyl-2-thiophenecarboximidamide,N′Hydroxy-4-(spiro[cyclohexane-1,3′-[3H]indol]-2′-hydroxyimino)-5′-yl-2-thiophenecarboximidamide,N′-Hydroxy-5-(spiro[cyclohexane-1,3′-[3H]indol]-2′-(hydroxyimino)-5′-yl)-2-thiophenecarboxidamide,5′-(3-Chlorophenyl)spiro[cyclohexane-1,3′-[3H]indol]-2′-ylidenecyanamide,5′-(3-Cyano-5-fluorophenyl)spiro[cyclohexane-1,3′-[3H]indol]-2′-ylidenecyanamide,5′-(5-Cyano-1H-pyrrol-2-yl)spiro[cyclohexane-1,3′-[3H]indol]-2-ylidenecyanamide,5′-(5-Cyano-thiophen-2-yl)spiro[cyclohexane-1,3′-[3H]indol]-2′-ylidenecyanamide,5′-(5-Cyano-3-methyl-thiophen-2-yl)spiro[cyclohexane-1,3′-[3H]indol]-2′-ylidenecyanamide,5′-(5-Cyano-thiophen-3-yl)spiro[cyclohexane-1,3′-[3H]indol]-2′-ylidenecyanamide,3-(2′-Cyanomethylene-spiro[cyclohexane-1,3′-[3H]indol]-5′-yl)-5-fluoro-benzonitrile,5-(2′-Cyanomethylene-spiro[cyclohexane-1,3′-[3H]indol]-5′-yl)-1H-pyrrole-2-carbonitrile,5-(2′-Cyanomethylene-spiro[cyclohexane-1,3′-[3H]indol]-5′-yl)-1-methyl-1H-pyrrole-2-carbonitrile,5-(2′-Cyanomethylene-spiro[cyclohexane-1,3′-[3H]indol]-5′-yl)-thiophene-2-carbonitrile,5-(2′-Cyanomethylene-spiro[cyclohexane-1,3′-[3H]indol]-5′-yl)-4-methyl-thiophene-2-carbonitrile,and4-(2′-Cyanomethylene-spiro[cyclohexane-1,3′-[3H]indol]-5′-yl)-thiophene-2-carbonitrile,or a pharmaceutically acceptable salt, tautomer, metabolite, or prodrugthereof. Preferably, the compound is5′-(5-Cyano-1-methyl-1H-pyrrol-2-yl)spiro[cyclohexane-1,3′-[3H]indol]-2′-ylidenecyanamide, or a pharmaceuticallyacceptable salt, tautomer, metabolite, or prodrug thereof.

The compounds utilized according to the present invention can containone or more asymmetric centers and can thus give rise to optical isomersand diastereomers. While shown without respect to stereochemistry, thecompounds can include optical isomers and diastereomers; racemic andresolved enantiomerically pure R and S stereoisomers; other mixtures ofthe R and S stereoisomers; and pharmaceutically acceptable saltsthereof.

The term “alkyl” is used herein to refer to both straight- andbranched-chain saturated aliphatic hydrocarbon groups having about 1 toabout 8 carbon atoms, and preferably about 1 to about 6 carbon atoms.The term “alkenyl” is used herein to refer to both straight- andbranched-chain alkyl groups having one or more carbon-carbon doublebonds and containing about 2 to about 8 carbon atoms. Preferably, theterm alkenyl refers to an alkyl group having 1 or 2 carbon-carbon doublebonds and having 2 to about 6 carbon atoms. The term “alkynyl” group isused herein to refer to both straight- and branched-chain alkyl groupshaving one or more carbon-carbon triple bond and having 2 to about 8carbon atoms. Preferably, the term alkynyl refers to an alkyl grouphaving 1 or 2 carbon-carbon triple bonds and having 2 to about 6 carbonatoms.

The terms “substituted alkyl”, “substituted alkenyl”, and “substitutedalkynyl” refer to alkyl, alkenyl, and alkynyl groups, respectively,having one or more substituents including, without limitation, halogen,CN, OH, NO₂, amino, aryl, heterocyclic groups, aryl, alkoxy, aryloxy,alkyloxy, alkylcarbonyl, alkylcarboxy, amino, and arylthio which groupscan be optionally substituted.

The term “acyl” as used herein refers to a carbonyl substituent, i.e., aC(O)(R) group where R is a straight- or branched-chain saturatedaliphatic hydrocarbon group including, without limitation, alkyl,alkenyl, and alkynyl groups. Preferably, the R groups have 1 to about 8carbon atoms, and more preferably 1 to about 6 carbon atoms. The term“substituted acyl” refers to an acyl group which is substituted with 1or more groups including halogen, CN, OH, and NO₂.

The term “aryl” as used herein refers to an aromatic system which caninclude a single ring or multiple aromatic rings fused or linkedtogether where at least one part of the fused or linked rings forms theconjugated aromatic system. The aryl groups include, but are not limitedto, phenyl, naphthyl, biphenyl, anthryl, tetrahydronaphthyl,phenanthryl, indene, benzonaphthyl, fluorenyl, and carbazolyl.

The term “substituted aryl” refers to an aryl group which is substitutedwith one or more substituents including halogen, CN, OH, NO₂, amino,alkyl, cycloalkyl, alkenyl, alkynyl, alkoxy, aryloxy, alkyloxy,alkylcarbonyl, alkylcarboxy, alkylamino, and arylthio, which groups canbe optionally substituted. Preferably, a substituted aryl group issubstituted with 1 to about 4 substituents.

The term “heterocyclic” as used herein refers to a stable 4- to7-membered monocyclic or multicyclic heterocyclic ring which issaturated, partially unsaturated, or wholly unsaturated. Theheterocyclic ring has in its backbone carbon atoms and one or moreheteroatoms including nitrogen, oxygen, and sulfur atoms. Preferably,the heterocyclic ring has about 1 to about 4 heteroatoms in the backboneof the ring. When the heterocyclic ring contains nitrogen or sulfuratoms in the backbone of the ring, the nitrogen or sulfur atoms can beoxidized. The term “heterocyclic” also refers to multicyclic rings inwhich a heterocyclic ring is fused to an aryl ring. The heterocyclicring can be attached to the aryl ring through a heteroatom or carbonatom provided the resultant heterocyclic ring structure is chemicallystable.

A variety of heterocyclic groups are known in the art and include,without limitation, oxygen-containing rings, nitrogen-containing rings,sulfur-containing rings, mixed heteroatom-containing rings, fusedheteroatom containing rings, and combinations thereof. Oxygen-containingrings include, but are not limited to, furyl, tetrahydrofuranyl,pyranyl, pyronyl, and dioxinyl rings. Nitrogen-containing rings include,without limitation, pyrrolyl, pyrazolyl, imidazolyl, triazolyl, pyridyl,piperidinyl, 2-oxopiperidinyl, pyridazinyl, pyrimidinyl, pyrazinyl,piperazinyl, azepinyl, triazinyl, pyrrolidinyl, and azepinyl rings.Sulfur-containing rings include, without limitation, thienyl anddithiolyl rings. Mixed heteroatom containing rings include, but are notlimited to, oxathiolyl, oxazolyl, thiazolyl, oxadiazolyl, oxatriazolyl,dioxazolyl, oxathiazolyl, oxathiolyl, oxazinyl, oxathiazinyl,morpholinyl, thiamorpholinyl, thiamorpholinyl sulfoxide, oxepinyl,thiepinyl, and diazepinyl rings. Fused heteroatom-containing ringsinclude, but are not limited to, benzofuranyl, thionapthene, indolyl,benazazolyl, purindinyl, pyranopyrrolyl, isoindazolyl, indoxazinyl,benzoxazolyl, anthranilyl, benzopyranyl, quinolinyl, isoquinolinyl,benzodiazonyl, napthyridinyl, benzothienyl, pyridopyridinyl,benzoxazinyl, xanthenyl, acridinyl, and purinyl rings.

The term “substituted heterocyclic” as used herein refers to aheterocyclic group having one or more substituents including halogen,CN, OH, NO₂, amino, alkyl, cycloalkyl, alkenyl, alkynyl, alkoxy,aryloxy, alkyloxy, alkylcarbonyl, alkylcarboxy, alkylamino, andarylthio, which groups can be optionally substituted. Preferably, asubstituted heterocyclic group has 1 to 4 substituents.

The term “aroyl” as used herein refers to a carbonyl substituent boundto a phenyl or heterocyclic group. Preferably, the aroyl heterocyclicgroups include 2-pyridinyl, 3-pyridinyl, 2-furanyl, 3-furanyl,3-thiophenyl, 2-pyrimidinyl, and 4-pyrimidinyl groups. The term“substituted aroyl” refers to an aroyl group which is substituted withone or more groups including, without limitation, halogen, CN, OH, andNO₂

The term “thioalkyl” as used herein is used interchangeably with theterm “thioalkoxy”, with both referring to an S(alkyl) group, where thepoint of attachment is through the sulfur-atom and the alkyl group canbe optionally substituted.

The term “arylthio” as used herein refers to the S(aryl) group, wherethe point of attachment is through the sulfur-atom and the aryl groupcan be optionally substituted.

The term “alkoxy” as used herein refers to the O(alkyl) group, where thepoint of attachment is through the oxygen-atom and the alkyl group isoptionally substituted. The term “aryloxy” as used herein refers to theO(aryl) group, where the point of attachment is through the oxygen-atomand the aryl group is optionally substituted.

The term “alkylcarbonyl” as used herein refers to the C(O)(alkyl) group,where the point of attachment is through the carbon-atom of the carbonylmoiety and the alkyl group is optionally substituted.

The term “alkylcarboxy” as used herein refers to the C(O)O(alkyl) group,where the point of attachment is through the carbon-atom of the carboxymoiety and the alkyl group is optionally substituted.

The term “aminoalkyl” as used herein refers to both secondary andtertiary amines where the point of attachment is through thenitrogen-atom and the alkyl groups are optionally substituted. The alkylgroups can be the same or different.

The term “halogen” as used herein refers to Cl, Br, F, or I groups.

The compounds of the present invention encompass tautomeric forms of thestructures provided herein characterized by the bioactivity of the drawnstructures. Further, the compounds of the present invention can be usedin the form of salts derived from pharmaceutically or physiologicallyacceptable acids, bases, alkali metals and alkaline earth metals.

Physiologically acceptable acids include those derived from inorganicand organic acids. A number of inorganic acids are known in the art andinclude hydrochloric, hydrobromic, hydroiodic, sulfuric, nitric, andphosphoric acids, among others. Similarly, a variety of organic acidsare known in the art and include, without limitation, lactic, formic,acetic, fumaric, citric, propionic, oxalic, succinic, glycolic,glucuronic, maleic, furoic, glutamic, benzoic, anthranilic, salicylic,tartaric, malonic, mallic, phenylacetic, mandelic, embonic,methanesulfonic, ethanesulfonic, panthenoic, benzenesulfonic,toluenesulfonic, stearic, sulfanilic, alginic, and galacturonic acids,among others.

Physiologically acceptable bases include those derived from inorganicand organic bases. A number of inorganic bases are known in the art andinclude aluminum, calcium, lithium, magnesium, potassium, sodium, andzinc sulfate or phosphate compounds, among others. A number of organicbases are known in the art and include, without limitation,N,N,-dibenzylethylenediamine, chloroprocaine, choline, diethanolamine,ethylenediamine, meglumine, and procaine, among others.

Physiologically acceptable alkali salts and alkaline earth metal saltscan include, without limitation, sodium, potassium, calcium andmagnesium salts in the form of esters, and carbamates. Otherconventional “pro-drug” forms can also be utilized which, when deliveredin such form, convert to the active moiety in vivo.

These salts, as well as other compounds of the invention can be in theform of esters, carbamates and other conventional “pro-drug” forms,which, when administered in such form, convert to the active moiety invivo. In a currently preferred embodiment, the prodrugs are esters. See,e.g., B. Testa and J. Caldwell, “Prodrugs Revisited: The “Ad Hoc”Approach as a Complement to Ligand Design”, Medicinal Research Reviews,16(3):233-241, ed., John Wiley & Sons (1996).

As described herein, the compounds of formula I and/or salts, prodrugsor tautomers thereof, are delivered in regimens which further involvedelivery of SERMS.

The compounds discussed herein also encompass “metabolites” which areunique products formed by processing the compounds of the invention bythe cell or patient. Preferably, metabolites are formed in vivo.

The SERMs used in the compositions and methods of the present inventioncan be chemically synthesized according to known methods, and includethe salt forms of the compounds including tamoxifene(Nolvadex—AstraZeneca); 4-hydroxy-tamoxifene (AstraZeneca); raloxifene(Evista—Eli Lilly); droloxifene (Pfizer); toremifene(Fareston—Schering); iodotamoxifen (AstraZeneca); idoxifene (GSK);ICI182780 (Faslodex—AstraZeneca); EM-800 (Schering); EM-652 (Schering);arzoxifene (Eli Lilly); lasofoxifene (Pfizer); clomiphene(Clomid—Aventis); pipendoxifene (Wyeth); tibolone (Livial);levormeloxifene (Takeda and Novo Nordisk); centchroman (Saheli—HindustanLatex and Centron—Torrent); bazedoxifene (Wyeth); and ZK186619(Schering). Other SERMS include cycladiene (Dienestrol); nafoxidine;nitromifene citrate;13-ethyl-17α-ethynyl-17β-hydroxygona-4-9-11-trien-3-one; diphenolhydrochryscne; erythro-MEA; allenolic acid; cyclofenyl; chlorotrianisene(TACE); ethamoxytriphetol (MER-25); triparanol; CI-626; CI-680;U-11,555A; U-11,100A; ICI-46,669; ICI-46,474; and CN-55,945 as describedin U.S. Pat. No. 6,258,802. Preferably, the SERM is raloxifenehydrochloride, arzoxifene, lasofoxifene, droloxifene, tamoxifen citrate,4-hydroxytamoxifen citrate, clomiphene citrate, toremifene citrate,pipendoxifene, or bazedoxifene.

The compounds of formula I useful in this invention can be preparedfollowing the Schemes illustrated below.

According to Scheme 1, commercially available oxindole 3 can be treatedwith a strong organometallic base (e.g. butyl lithium, lithiumdiisopropylamide, potassium hexamethyldisilazide) in an inert solvent(e.g. THF, diethyl ether) under nitrogen at reduced temperature (ca.-20°C.) (Kende, et al, Synth. Commun., 12, 1, 1982) in the presence oflithium chloride or N,N,N′,N′-tetramethylethylenediamine. The resultingdi-anion can then treated with excess electrophile such as an alkylhalide, preferably an iodide. If R₁ and R₂ are to be joined such as theproduct 4 contains a spirocycle at position 3, then the electrophileshould be bifunctional, i.e. a diiodide. Subsequent bromination of 4proceeds smoothly with bromine in acetic acid (an organic co-solventsuch as dichloromethane can be added as required) in the presence ofsodium acetate, to afford the aryl bromide 5. The bromide 5 can bereacted with a palladium salt (e.g.tetrakis(triphenylphosphine)palladium(0) or palladium acetate), in asuitable solvent (e.g. THF, dimethoxyethane, acetone, ethanol ortoluene) at room temperature under an inert atmosphere (argon,nitrogen). The mixture can then treated with an aryl or heteroarylboronic acid or boronic acid ester and a base (sodium carbonate,triethylamine, potassium phosphate) in water or fluoride source (cesiumfluoride) under anhydrous conditions. The required product 6 can thenisolated and purified by standard means.

Reaction of the indoline-2-one derivative 6 with either Lawessen'sreagent or phosphorous pentasulfide in a suitable organic solvent(pyridine, THF, dioxane, dimethoxyethane, dichloromethane, benzene,toluene, xylene) at a temperature between room temperature and thereflux temperature of the solvent can provide access to the thiocarbonylderivative 7. An additive such as sodium hydrogen carbonate can also beuseful.

If R₁ and R₂ are different then the intermediate 4 can be prepared byreacting the dianion of 3 with one equivalent of the electrophile R₁—X(X=leaving group e.g. iodine). The resultant mono-alkylated compound canthen be isolated and re-subjected to the reaction conditions using R₂—X,or alternatively used in-situ for the second alkylation with R₂—X.Alternatively if the desired product 7 is to contain R₂═H, then theisolated mono-alkylated intermediate can be taken though the subsequentsteps.

Other methodologies are also available for coupling the pendant aryl orheteroaryl group, Ar, to the oxindole platform, for example reaction ofcompound 5 with an aryl or heteroaryl stannane, aryl or heteroaryl zinc,or aryl or heteroaryl magnesium halide in the presence of a palladium ornickel catalyst (Scheme 2). The required aryl or heteroaryl-metallicspecies described above are formed through standard techniques.

Other functionalities can also be installed into the 3-position of theindoline platform according to Scheme 3. Oxidation of the unsubstitutedindoline 8, preferably under neutral or acidic conditions (e.g. seleniumdioxide in dry dioxane at reflux) can afford the isatin 9. Compound 9can be further functionalized to provide a ketal 11 by treatment with analcohol and acid catalyst under dehydrating conditions. Alternativelyreaction of 9 with a second ketone under suitable conditions (piperidinein toluene at reflux; or TiCl₄/Zn in THF at reflux) can affordalkylidene derivatives 11. Reaction of the isatin 9 with a Grignardreagent or organolithium affords tertiary alcohols 12 (R═H). Thesealcohols can then be further functionalized by alkylation or acylationprocedures.

Reaction of the indoline-2-one derivative 6 with either Lawessen'sreagent or phosphorous pentasulfide in a suitable organic solvent(pyridine, THF, dioxane, dimethoxyethane, dichloromethane, benzene,toluene, xylene) at a temperature between room temperature and thereflux temperature of the solvent provides access to the thiocarbonylderivative 7. An additive such as sodium hydrogen carbonate can also beuseful.

An alternative mode of preparation is to react compound 5 with eitherLawessen's reagent or phosphorous pentasulfide in a suitable organicsolvent (pyridine, THF, dioxane, dimethoxyethane, dichloromethane,benzene, toluene, xylene) at a temperature between room temperature andthe reflux temperature of the solvent, under an inert atmosphere(nitrogen or argon) providing access to the thiocarbonyl derivative 13.The reaction of bromide 13 in an anhydrous solvent (e.g. THF, Et₂O) witha strong base (sodium hydride preferred, sodium hexamethyldisilazide,potassium hydride) followed by reaction at reduced temperature (−50 to−20° C.) with n-butyllithium and N,N,N,N′-tetramethylethylenediaminefollowed after a suitable period of time by a trialkylborate (trimethylor triisopropylborate) gives after acidic work-up the boronic acid 14(Scheme 4). Compound 14 can then be reacted under palladium catalyzedconditions tetrakis(triphenylphosphine)palladium(0) or palladiumacetate, base (NaHCO₃, Na₂CO₃, K₂CO₃, triethylamine, CsF) solvent(toluene/EtOH/water, THF/water, dimethoxyethane/water, anhydrousdimethoxyethane) with an aryl or heteroaryl bromide, aryl or heteroaryliodide, aryl or heteroaryl trifluoromethane sulfonate or aryl orheteroaryl fluorosulfonate, to provide the desired compounds 7.

Alternatively reaction of compound 13 under palladium catalyzedconditions tetrakis(triphenylphosphine)palladium(0) or palladiumacetate, base (NaHCO₃, Na₂CO₃, K₂CO₃, triethylamine, CsF) solvent(acetone/water, toluene/EtOH/water, THF/water, dimethoxyethane/water,anhydrous dimethoxyethane) with an aryl or heteroaryl bromide, aryl orheteroaryl iodide, aryl or heteroaryl trifluoromethane sulfonate or arylor heteroaryl fluorosulfonate, to provide the desired compound 7.

Treatment of the bromide 5 in an anhydrous solvent (e.g. THF, Et₂O) witha strong base (sodium hydride preferred, sodium hexamethyldisilazide,potassium hydride) followed by reaction at reduced temperature (−50 to−20° C.) with n-butyllithium and N,N,N,N′-tetramethylethylenediaminefollowed after a suitable period of time by a trialkylborate (trimethylor triisopropylborate) gives after acidic work-up the boronic acid 15(Scheme 5). Compound 15 can then be reacted under palladium catalyzedconditions tetrakis(triphenylphosphine)palladium(0), base (NaHCO₃,Na₂CO₃, K₂CO₃, triethylamine, CsF) solvent (toluene/EtOH/water,THF/water, dimethoxyethane/water, anhydrous dimethoxyethane) with anaryl or heteroaryl bromide, aryl or heteroaryl iodide, aryl orheteroaryl trifluoromethane sulfonate or aryl or heteroarylfluorosulfonate, to provide the desired compounds 6.

An alternative strategy can be to prepare an organozinc or magnesiumreagent from compound 5 and react it in-situ with an aryl or heteroarylbromide, aryl or heteroaryl iodide, aryl or heteroaryl trifluoromethanesulfonate of aryl or heteroaryl fluorosulfonate, under palladiumcatalyzed conditions to afford compound 6. Such an organozinc ormagnesium species could be prepared by treatment of the bromide 7 in ananhydrous solvent (e.g. THF, Et₂O) with a strong base (sodium hydridepreferred, sodium hexamethyldisilazide, potassium hydride) followed byreaction at reduced temperature (−50 to −20° C.) with n-butyllithium andN,N,N′,N′-tetramethylethylenediamine followed after a suitable period oftime by reaction with anhydrous zinc chloride or magnesium bromide.

Reaction of the indoline-2-one derivative 6 with either Lawesson'sreagent or phosphorous pentasulfide in a suitable organic solvent(pyridine, THF, dioxane, dimethoxyethane, dichloromethane, benzene,toluene, xylene) at a temperature between room temperature and thereflux temperature of the solvent, under an inert atmosphere (nitrogenor argon) provides access to the thiocarbonyl derivative 15. An additivesuch as sodium hydrogen carbonate can also be useful.

According to Scheme 6, thioamide derivative 7 can be converted intoenamine derivative 16 (Wrobel, et al, J. Med. Chem., 1989, 2493).

Thus, reaction of thioamide 7 (Pg=H, 2-(trimethylsilyl)-ethoxymethyl,benzyl, etc) with triethyloxonium tetrafluoroborate followed by reactionwith a nucleophile (nitromethane, cyanamide,trifluoromethanesulfonamide, Meldrum's acid, etc.) followed by removalof the protecting group under appropriate conditions (e.g.tetrabutylammonium fluoride in THF forPg=2-(trimethylsilyl)-ethoxymethyl) gives the enamine derivatives 16.Appropriate solvents for the two steps are selected fromdichloromethane, THF, dioxane, 1,2-dichloroethane, and the reaction canconducted at a temperature from −78° C. to the boiling point of thesolvent under an inert atmosphere (nitrogen or argon).

According to Scheme 7, treatment of intermediate 7 with an alkylatingagent, e.g., methyl iodide, ethyl iodide, 2,4-dinitrofluoro benzene, or4-nitro fluorobenzene, in the presence of a suitable base (e.g. an aminebase such as pyridine, triethylamine or di-iso-propylethylamine orlithium, sodium, potassium or cesium carbonate) in a suitable organicsolvent (e.g. DMF, THF, DMSO, dioxane or acetonitrile) at a temperaturebetween −78° C. and the boiling point of the solvent, can then affordthioimino ether 17. Subsequent reaction of intermediate 17 withhydroxylamine or an acid salt of hydroxylamine (e.g. the hydrochloride)in a suitable solvent (for example, but not limited to, pyridinemethanol, ethanol, iso-propanol, DMF, THF or DMSO and optionally in thepresence of an additive such as a tertiary amine base or sodium orpotassium acetate) at a temperature between −78° C. and the boilingpoint of the solvent can then afford the N-hydroxyamidine 18.

Similarly treatment of intermediate 17 with a carbon nucleophile such asa malonate derivative (e.g., malononitrile, a cyano acetate ester, anitro acetate ester or a malonate) in the presence of a suitable base(e.g. an amine base such as pyridine, triethylamine ordi-iso-propylethylamine or lithium, sodium, potassium or cesiumcarbonate) or a Lewis acid (e.g. boron trifluoride etherate, a lead IIsalt, titanium tetrachloride, a magnesium II salt, or a silver salt) ina solvent compatible with the chosen base or Lewis acid (e.g. DMF, THF,DMSO, dioxane or acetonitrile, chloroform, benzene, toluene ordichloromethane) can then afford the adduct 19. If the R³ group inadduct 19 is an ester of a carboxylic acid, then it can bedecarboxylated directly to give the enamine derivative 20 by treatmentwith, e.g. sodium iodide in DMSO at a temperature between roomtemperature and the boiling point of the solvent. Alternatively theester can be first hydrolyzed to the carboxylic acid by treatment withan aqueous base (e.g. lithium, sodium, or potassium hydroxide) in asuitable solvent (e.g. THF, dioxane acetonitrile, methanol or ethanol),followed by decarboxylation in the presence of an acid (e.g.hydrochloric or sulfuric acid) in a suitable solvent (e.g. acetonitrile,THF, dioxane) to afford the derivative 20. Alternatively the xanthateester of the carboxylic acid can be prepared by reaction with a basesuch as sodium or potassium hydride in THF, followed by treatment withcarbon disulfide. Subsequent reaction with tributyl tin hydride atelevated temperatures in a solvent such as benzene or toluene under aninert nitrogen or argon atmosphere in the presence of a radicalinitiator such as benzoyl peroxide or azo-bis-iso-butyronitrile wouldthen give the product 20.

An alternative strategy for synthesizing the product 18 is illustratedby Scheme 8. The bromide 13 (the corresponding chloride, iodide ortriflate ester can also be employed) can be treated with an alkylatingagent, e.g., methyl iodide, ethyl iodide, 2,4-dinitrofluoro benzene, or4-nitro fluorobenzene, in the presence of a suitable base (e.g. an aminebase such as pyridine, triethylamine or di-iso-propylethylamine orlithium, sodium, potassium or cesium carbonate) in a suitable organicsolvent (e.g. DMF, THF, DMSO, dioxane or acetonitrile) at a temperaturebetween −78° C. and the boiling point of the solvent, to affordthioimino ethers 21. Subsequent reaction of intermediate 21 withhydroxylamine or an acid salt of hydroxylamine (e.g. the hydrochloride,hydrobromide) in a suitable solvent (for example but not limited topyridine methanol, ethanol, iso-propanol, DMF, THF or DMSO andoptionally in the presence of an additive such as a tertiary amine baseor sodium or potassium acetate) at a temperature between −78° C. and theboiling point of the solvent, would then afford the N-hydroxyamidine 22.Intermediate 22 could then be protected with a compatible group (e.g.benzyl ether, acyl derivative, tetrahydropyranyl ether, methoxy methylether, silyl ether) to give the derivative 23. Alternately, compound 21can be reacted directly with a protected hydroxylamine derivative(chosen, but not limited to, from the protecting groups described above)to directly afford derivative 23. Compound 23 can then be reacted with apalladium salt (e.g. tetrakis(triphenylphosphine)palladium(0) orpalladium acetate), in a suitable solvent (e.g. THF, dimethoxyethane,acetone, ethanol or toluene) at room temperature under an inertatmosphere (argon, nitrogen). The mixture can then treated with an arylor heteroaryl boronic acid or boronic acid ester and a base (sodiumcarbonate, triethylamine, potassium phosphate) in water or fluoridesource (cesium fluoride) under anhydrous conditions, and the reactioncan then be heated to the boiling point of the solvent. The requiredproduct 24 is then isolated and purified by standard means.

Compound 24 can then be deprotected under the conditions prescribed bythe nature of the protecting group. For example, if the protecting groupis a benzyl ether then treatment with boron tribromide or trimethylsilyliodide in a suitable solvent (dichloromethane for example) can affordthe compound 18. Other methods to remove the benzyl ether can involvehydrogenation (hydrogen gas or other hydrogen source such ascyclohexadiene or ammonium formate) in the presence of a palladiumcatalyst. Solvents suitable for such a process include methanol,ethanol, THF, ethyl acetate and dioxane, at a temperature between roomtemperature and the boiling point of the solvent. If the protectinggroup was an acetal derivative (tetrahydropyranyl or methoxymethylethers) then hydrolysis could be effected under acidic conditions(hydrochloric acid, sulfuric acid, p-toluene sulfonic acid or acidic ionexchange resin) in a solvent such as methanol, ethanol, THF dioxane oracetonitrile. If the protecting group was an acyl derivative (acetate,or benzoate for example) then hydrolysis can be effected under acidicconditions as described above or under basic conditions (lithium, sodiumor potassium hydroxide) in a solvent such as an alcohol, THF dioxane oracetonitrile at a temperature between room temperature and the boilingpoint of the solvent. If the protecting group was a silyl ether, thencompound 18 can be prepared by hydrolyzing intermediate 24 under theacidic conditions described above or alternately by exposing compound 24to a fluoride source (e.g., potassium fluoride, cesium fluoride ortetrabutylammonium fluoride) in a solvent such as an alcohol, THFdioxane or acetonitrile at a temperature between room temperature andthe boiling point of the solvent. An inert atmosphere of nitrogen orargon can be necessary.

Another method of synthesizing compound 18 can be to convert theprotected N-hydroxy amidine 23 into a boronic acid or boronic acid ester(by lithium halogen exchange followed by quench with tri-isopropylborate, or palladium catalyzed coupling with diboron pinacolate) andthen couple this boronic acid or ester derivative with an aryl chloride,bromide, iodide or triflate under a suitable palladium catalysis systemas described previously. Subsequent deprotection as described for Scheme8 can afford the desired compounds 18.

According to Scheme 9, treatment of the N-hydroxyamidine 18 underreducing conditions (e.g. catalytic hydrogenation, iron in acetic acidor hydrazine-raney nickel) can then afford intermediate 25. Solventssuitable for such a process include methanol, ethanol, THF, ethylacetate and dioxane, at a temperature between room temperature and theboiling point of the solvent. Protection of the secondary nitrogen (atertiary butyl carbamate is shown as a non-limiting example) understandard conditions can then give compound 26. Reaction of compound 26with an electrophilic cyanating agent (e.g. cyanogen bromide,N-cyanobenzotriazole or cyanogen bromide/4-dimethylaminopyridinecomplex) in a suitable solvent (THF acetonitrile or DMF, optionally inthe presence of a base such as pyridine or sodium hydride or potassiumtert-butoxide) can then afford the desired compound 27. In some cases,the cyanation step can occur with concomitant removal of the secondarynitrogen protecting group, if this deprotection does not occur in-situthen a further hydrolysis step can be required.

An alternate synthesis of compound 27 can follow that of compound 18,Scheme 8, where an N-cyanoamidine bromide 28, prepared from compound 22adopting a similar strategy to the reactions shown in Scheme 9, can becoupled with a suitable functionalized aryl boronic acid or boronic acidester to give compound 27. In another strategy intermediate 28 can beconverted into the corresponding boronic acid or boronic acid ester andcoupled in a Suzuki or Suzuki type palladium coupling with a suitablefunctionalized aryl bromide.

II. Formulations of the Invention

The compounds of formula I and the SERMS described herein can beformulated separately, or in a combined formulation, in any formsuitable for the desired route of delivery using a pharmaceuticallyeffective amount of one or more of the compounds of formula I, orcombinations thereof. For example, the compositions of the invention canbe delivered by a route such as oral, dermal, transdermal,intrabronchial, intranasal, intravenous, intramuscular, subcutaneous,parenteral, intraperitoneal, intranasal, vaginal, rectal, sublingual,intracranial, epidural, intratracheal, or by sustained release.Preferably, delivery is oral or transdermal. Optionally, the compoundsof formula I are delivered in a regimen with one or more SERMS, but witheach active component delivered by different routes.

A pharmaceutically effective amount of the compositions used accordingto the present invention can vary depending on the specificcompositions, mode of delivery, severity of the hormone relatedcondition being treated, and any other active ingredients used in theformulation or the selected regimen, among others. The dosing regimencan be adjusted to provide the optimal therapeutic response. Severaldivided doses can be delivered daily, e.g., in divided doses 2 to 4times a day, or a single daily dose can be delivered. The dose canhowever be proportionally reduced or increased as indicated by theexigencies of the therapeutic situation. When the compound(s) of formulaI and the SERM(s) are delivered separately, the dosing schedule for eachcan be the same, or can differ.

Preferably, the delivery can be on a daily, weekly, or monthly basis,and more preferably on a daily delivery. Daily dosages can be lowered orraised based on the periodic delivery.

Preferably, the compound(s) of formula I are delivered at a daily dosageof from about 0.1 to about 500 mg body weight, more preferably at atotal daily dosage is from about 0.1 to about 100 mg, and mostpreferably from about 0.1 to about 50 mg. Preferably, the amount of SERMutilized according to the present invention is preferably at least 0.2mg per day, more preferably from about 0.2 mg to about 200 mg per day,and most preferably from about 0.2 mg to about 100 mg per day. Thecompounds of formula I and/or the SERMs can be combined with one or morepharmaceutically acceptable carriers or excipients including, withoutlimitation, solid and liquid carriers. Where formulated together, thecomponents are selected to be compatible with the PR modulators used inthe invention. Such carriers can include adjuvants, syrups, elixirs,diluents, binders, lubricants, surfactants, granulating agents,disintegrating agents, emollients, and combinations thereof.

Adjuvants can include, without limitation, flavoring agents, coloringagents, preservatives, and supplemental antioxidants, which can includevitamin E, ascorbic acid, butylated hydroxytoluene (BHT) and butylatedhydroxyanisole (BHA).

Elixers and/syrups can be prepared from acceptable sweeteners such assugar, saccharine or a biological sweetener, a flavoring agent, and/orsolvent. In one embodiment, a syrup can contain about 10 to about 50% ofa sugar carrier. In another embodiment, the elixir can contain about 20to about 50% of an ethanol carrier.

Diluents can include materials in which the compositions can bedispersed, dissolved, or incorporated. Preferably, the diluents includewater, lower monovalent alcohols, and low molecular weight glycols andpolyols, including propylene glycol, diethylene glycol, polyethyleneglycol, polypropylene glycol, glycerol, butylene glycol,1,2,4-butanetriol, sorbitol esters, 1,2,6-hexanetriol, ethanol,isopropanol, sorbitol esters, butanediol, ether propanol, ethoxylatedethers, propoxylated ethers, oils such as corn, peanut and sesame oils,dimethylsulfoxide (DMSO), dimethylformamide (DMF), and combinationsthereof. Preferably, the diluent is water.

Binders can include, without limitation, cellulose, methylcellulose,hydroxymethylcellulose, polypropylpyrrolidone, polyvinylpyrrolidone,gelatin, gum arabic, polyethylene glycol, starch, sugars such assucrose, kaolin, and lactose, among others.

Lubricants can include magnesium stearate, light anhydrous silicic acid,talc and sodium lauryl sulfate, among others.

Granulating agents can include, without limitation, silicon dioxide,microcrystalline cellulose, starch, calcium carbonate, pectin, andcrospovidone, polyplasdone, among others.

Disintegrating agents can include starch, carboxymethylcellulose,hydroxypropylstarch, substituted hydroxypropylcellulose, sodiumbicarbonate, calcium phosphate, and calcium citrate, among others

Emollients can include, without limitation, stearyl alcohol, mink oil,cetyl alcohol, oleyl alcohol, isopropyl laurate, polyethylene glycol,olive oil, petroleum jelly, palmitic acid, oleic acid, and myristylmyristate.

III. Therapeutic Regimens

The present invention provides dosing regimens utilizing the compoundsof formula I in combination with one or more selective estrogen receptormodulators. The compositions can be delivered by a route such as oral,dermal, transdermal, intrabronchial, intranasal, intravenous,intramuscular, subcutaneous, parenteral, intraperitoneal, intranasal,vaginal, rectal, sublingual, intracranial, epidural, intratracheal, orby sustained release. Preferably, delivery is oral or transdermal.

In one embodiment, the compositions are delivered orally by tablet,capsule, microcapsules, dispersible powder, granule, suspension, syrup,elixir, and aerosol. Desirably, when the compositions are deliveredorally, delivery is by tablets and hard- or liquid-filled capsules.

In another embodiment, the compositions are delivered intravenously,intramuscularly, subcutaneously, parenterally and intraperitoneally inthe form of sterile injectable solutions, suspensions, dispersions, andpowders which are fluid to the extent that easy syringe ability exists.Such injectable compositions are sterile, stable under conditions ofmanufacture and storage, and free of the contaminating action ofmicroorganisms such as bacteria and fungi.

Injectable formations can be prepared by combining the compositions witha liquid. The liquid can be selected from among water, glycerol,ethanol, propylene glycol and polyethylene glycol, oils, and mixturesthereof, and more preferably the liquid carrier is water. In oneembodiment, the oil is vegetable oil. Optionally, the liquid carriercontains about a suspending agent. In another embodiment, the liquidcarrier is an isotonic medium and contains about 0.05 to about 5%suspending agent.

In a further embodiment, the compositions are delivered rectally in theform of a conventional suppository.

In another embodiment, the compositions are delivered vaginally in theform of a conventional suppository, cream, gel, ring, or coatedintrauterine device (IUD).

In yet another embodiment, the compositions are delivered intranasallyor intrabronchially in the form of an aerosol.

In a further embodiment, the compositions are delivered transdermally orby sustained release through the use of a transdermal patch containingthe composition and an optional carrier that is inert to thecompound(s), is nontoxic to the skin, and allows for delivery of thecompound(s) for systemic absorption into the blood stream. Such acarrier can be a cream, ointment, paste, gel, or occlusive device. Thecreams and ointments can be viscous liquid or semisolid emulsions.Pastes can include absorptive powders dispersed in petroleum orhydrophilic petroleum. Further, a variety of occlusive devices can beutilized to release the active reagents into the blood stream andinclude semi-permeable membranes covering a reservoir contain the activereagents, or a matrix containing the reactive reagents.

The use of sustained delivery devices can be desirable, in order toavoid the necessity for the patient to take medications on a dailybasis. The term “sustained delivery” is used herein to refer to delayingthe release of an active agent, i.e., compositions of the invention,until after placement in a delivery environment, followed by a sustainedrelease of the agent at a later time. A number of sustained deliverydevices are known in the art and include hydrogels (U.S. Pat. Nos.5,266,325; 4,959,217; 5,292,515), osmotic pumps (U.S. Pat. Nos.4,295,987 and 5,273,752 and European Patent No. 314,206, among others);hydrophobic membrane materials, such as ethylenemethacrylate (EMA) andethylenevinylacetate (EVA); bioresorbable polymer systems (InternationalPatent Publication No. WO 98/44964 and U.S. Pat. Nos. 5,756,127 and5,854,388); and other bioresorbable implant devices composed of, forexample, polyesters, polyanhydrides, or lactic acid/glycolic acidcopolymers (U.S. Pat. No. 5,817,343). For use in such sustained deliverydevices, the compositions of the invention can be formulated asdescribed herein. See, U.S. Pat. Nos. 3,845,770; 3,916,899; 3,536,809;3,598,123; and 4,008,719.

The compositions of the invention, including compounds of formula I, andSERMS can be delivered (separately or together) using the same deliveryroute. Preferably, the compounds of formula I and SERMS are deliveredorally or transdermally. Alternatively, the compounds of formula I andSERMS can be delivered using different delivery routes. In oneembodiment, the SERM is delivered orally and the compound of formula Iis delivery transdermally through the use of a patch.

The methods of the invention can include the continuous delivery of thecompounds of formula I and/or SERMS. In another embodiment, the methodsinclude the periodic discontinuation of the delivery of the compositionsof the invention and/or SERMS. Such periodic discontinuation can includedelivery of a placebo during the period of time where the compositionsof the invention or SERMS are not delivered to the patient.Alternatively, no placebo or active agent is delivered to the patientwhen the compositions and SERMS are not being delivered to the patient.

By the term “placebo” or “inactive agent” is meant a reagent havingpharmacological properties that are not relevant to the condition beingtreated, i.e., does not contain an active agent. Typical placebosinclude sugar as the primary constituent.

By the term “active agent” is meant any reagent which assists intreating a hormone-related condition.

The method of the present invention can be carried out over a cycle of21 or more days, preferably 21 or more consecutive days, more preferably21, 28, 30, or 31 days, and most preferably 21 or 28 days. One of skillin the art would readily be able to select and adjust the appropriateperiod of delivery.

The terminal portion of a cycle can be the last 1 to about 10 days ofthe cycle, and preferably the last 7 days of the cycle. In oneembodiment, the terminal portion of the 28-day cycle can include thelast 7 days of the cycle, i.e., days 22 to 28 of the 28-day cycle. Theterminal portion of a cycle can include the delivery of an agent otherthan the compositions of the invention or SERMS and is preferably aplacebo. Alternatively, no agent or placebo is delivered during theterminal portion of the cycle.

The regimen can include delivering a daily dosage of the compound offormula I and SERM, which are incorporated into a combined, single dailydosage unit. The regimen can also include delivering a single dailydosage unit of the compound of formula I and a single daily dosage unitof the SERM. Delivery of the compounds of formula I can be prior to,simultaneous with, or subsequent to the delivery of the SERM.

The regimen can further include alternating delivery of the compounds offormula I alone, the SERM alone, and a combination of the compound offormula I and the SERM. The regimen can also include the delivery ofanother reagent prior to, in conjunction with, or subsequent to thecompound of formula I and the SERM.

The regimen can further include alternating delivery of the compounds offormula I alone, a SERM alone, and a combination of the compound offormula I and the SERM. The regimen can also include the delivery ofanother reagent prior to, in conjunction with, or subsequent to thecompound of formula I and the SERM.

In one embodiment, a single combined daily dosage of the compound offormula I and a SERM can be delivered for the entire 21-day, 28-day,30-day, or 31-day cycle. Alternatively, a single combined daily dosageof the compound of formula I and an SERM can be delivered for the first21 days of a 28-day, 30-day, or 31-day cycle. A single combined dailydosage of the compound of formula I and an SERM can also be deliveredfor the first 24 days of a 28-day, 30-day, or 31-day cycle.

In a further embodiment, a daily dosage of the compound of formula I canbe delivered by one route of delivery and a daily dosage of a SERM canbe delivered by a second route of delivery for the entire 21-day,28-day, 30-day, or 31-day cycle. Alternatively, a daily dosage of thecompound of formula I can be delivered by one route of delivery and adaily dosage of a SERM can be delivered by a second route of deliveryfor the first 21 days of a 28-day, 30-day, or 31-day cycle. Further, adaily dosage of the compound of formula I can be delivered by one routeof delivery and a daily dosage of a SERM can be delivered by a secondroute of delivery for the first 24 days of a 28-day, 30-day, or 31-daycycle.

In another embodiment, a daily dose of the compound of formula I can bedelivered, followed by a daily dose of the SERM for the entire 21-day,28-day, 30-day, or 31-day cycle. Alternatively, a daily dose of thecompound of formula I can be delivered, followed by a daily dose of theSERM for the first 21 days of a 28-day, 30-day, or 31-day cycle.Alternatively, a daily dosage of the compound of formula I can bedelivered, followed by a daily dosage of the SERM for the first 24 daysof a 28-day, 30-day, or 31-day cycle.

In a further embodiment, the compounds of formula I are delivered withthe SERM for the first 14 to 24 days of a 28-day cycle, followed bydelivery of the SERM alone for a period of 1 to 11 days beginning on anycycle day between day 14 and 24.

In another embodiment, the compounds of formula I can be delivered forthe initial 18 to 21 days of a 28-day cycle, followed by delivery of theSERM alone for from 1 to 7 days.

In yet a further embodiment, the compounds of formula I can be deliveredalone over a 28 day cycle for the first 21 days, followed by delivery ofa SERM alone from day 22 to day 24.

In another embodiment, the compounds of formula I and an estrogen can bedelivered for the initial 21 days of a 28 day cycle, followed by a SERMalone from days 22 to 24.

The dosage regimens can be adjusted to provide the optimal therapeuticresponse. For example, several divided doses of each component can bedelivered daily or the dose can be proportionally increased or reducedas indicated by the exigencies of the therapeutic situation. In thedescriptions herein, reference to a daily dosage unit can also includedivided units which are delivered over the course of each day of thecycle contemplated.

This invention further provides methods of treatment and dosing regimensfurther utilizing in combination with these progestins, estrogens suchas ethinyl estradiol.

An isoflavone can alone be delivered or co-delivered with thecompositions of the present invention in an amount sufficient to assistin the treatment of carcinomas. A number of isoflavones can be utilizedand include, without limitation, genistein, daidzein, biochanin A,formononetin, and naturally occurring glucosides and glucosideconjugates. The amount of isoflavone sufficient to treat the carcinomais dependent on the particular isoflavone utilized, the amount andactivity of the co-delivered active agent, the size of the patient, theroute of delivery, and the severity of the carcinoma. The amount ofisoflavone sufficient to treat the hormone related condition ispreferably at least 1 mg per day, more preferably from about 1 mg toabout 1000 mg per day, and most preferably from about 50 mg to about 500mg per day.

Estrogens can also be included in the compositions of the presentinvention. The estrogen can include natural estrogens, syntheticestrogens, catechol estrogens, conjugated estrogens, and non-steroidalestrogens, among others, or pharmaceutically acceptable salts or estersthereof. In one embodiment, the estrogen is a natural estrogen includingestrone, including the acetate, propionate, sulfate, and sulfatepiperazine ester salts; estradiol, including the 3-benzoate,17b-cypionate, 17-proprionate, d-propionate, hemisuccinate,17-heptanotate, 17-undecanoate, and 17-valerate ester salts; or estriol.In another embodiment, the estrogen is a synthetic estrogen includingethinyl estradiol. In a further embodiment, the estrogen is a conjugatedestrogen including conjugated equine estrogens and sodium estronesulfate and is available in formulations for intravenous, intramuscular,and topical administration (Wyeth). In a further embodiment, theestrogen is a catechol estrogen including 2- or 4-hydroxyestrogens. Inyet another embodiment, the nonsteroidal estrogen is diethylstilbestrol.See, Chapter 50 entitled “Hormones” in Remington's PharmaceuticalSciences, 18^(th) Ed., Mack Publishing Company, Easton, Pa., 1990. Thedesired estrogen may however be selected from a variety of productscommercially available. One of skill in the art would readily be able toselect the estrogen, as well as dosage, that achieves the desiredeffect. Preferably, the estrogen is present in the formulation at about0.01 mg to about 1.0 mg.

Other reagents can also be delivered in combination with thecompositions of the present invention. Such reagents can include,chemotherapeutic agents, cytokines, androgens, and antiprogestins, amongothers. Preferably, the chemotherapeutic agents are taxol or cisplatin.Alternatively, such reagents can be alone administered prior orsubsequent to the composition of the invention. In addition, thecompositions of the invention can be delivered in conjunction with othercancer treatments, including radiation therapy and/or surgery.

As used herein, the terms “anti-progestational agents”,“anti-progestins” and “progesterone receptor antagonists” are understoodto be synonymous Similarly, “progestins”, “progestational agents” and“progesterone receptor agonists” are understood to refer to compounds ofthe same activity.

Optionally, progestins, other than those of formula I, can be deliveredin combination with the compositions of the present invention. A numberof progestins are known in the art and include, without limitation,progesterone, micronized progesterone, levonorgestrel, norgestrel,desogestrel, 3-ketodesogestrel, norethindrone, gestodene, norethindroneacetate, norgestimate, osaterone, cyproterone acetate, trimegestone,dienogest, drospirenone, nomegestrol, and (17-deacetyl)norgestimate,among others. Preferably, the progestins are levonorgestrel, gestodeneor trimegestone.

IV. Pharmaceutical Kits

The present invention provides kits or packages of pharmaceuticalformulations designed for use in the regimens described herein. Thesekits are preferably designed for daily oral delivery over 21-day,28-day, 30-day, or 31-day cycles, among others, and more preferably forone oral delivery per day. When the compositions and/or SERM are to bedelivered continuously, a package or kit can include the compositionand/or SERM in each tablet. When the compositions and/or SERM are to bedelivered with periodic discontinuation, a package or kit can includeplacebos on those days when the composition and SERM are not delivered.

The kits are also preferably organized to indicate a single oralformulation or combination of oral formulations to be taken on each dayof the cycle, preferably including oral tablets to be taken on each ofthe days specified, and more preferably one oral tablet will containeach of the combined daily dosages indicated.

In one embodiment, a kit can include a single phase of a daily dosage ofthe compound of formula I over a 21-day, 28-day, 30-day, or 31-daycycle. Alternatively, a kit can include a single phase of a daily dosageof the compound of formula I over the first 21 days of a 28-day, 30-day,or 31-day cycle. A kit can also include a single phase of a daily dosageof the compound of formula I over the first 28 days of a 30-day or31-day cycle.

In a further embodiment, a kit can include a single combined phase of adaily dosage of the compound of formula I and a SERM over a 21-day,28-day, 30-day, or 31-day cycle. Alternatively, a kit can include asingle combined phase of a daily dosage of the compound of formula I anda SERM over the first 21 days of a 28-day, 30-day, or 31-day cycle. Akit can also include a single combined phase of a daily dosage of thecompound of formula I and a SERM over the first 28 days of a 30-day or31-day cycle.

In another embodiment, a 28-day kit can include a first phase of from 14to 28 daily dosage units of the compound of formula I; a second phase offrom 1 to 11 daily dosage units of a SERM; and, optionally, a thirdphase of an orally and pharmaceutically acceptable placebo for theremaining days of the cycle.

In yet a further embodiment, a 28-day kit can include a first phase offrom 14 to 21 daily dosage units of the compound of formula I; a secondphase of from 1 to 11 daily dosage units of a SERM; and, optionally, athird phase of an orally and pharmaceutically acceptable placebo for theremaining days of the cycle.

In another embodiment, a 28-day kit can include a first phase of from 18to 21 daily dosage units of a compound of formula I; a second phase offrom 1 to 7 daily dose units of a SERM; and, optionally, an orally andpharmaceutically acceptable placebo for each of the remaining 0 to 9days in the 28-day cycle.

In a preferred embodiment, a 28-day kit can include a first phase of 21daily dosage units of a compound of formula I; a second phase of 3 dailydosage units for days 22 to 24 of a SERM; and, optionally, a third phaseof 4 daily units of an orally and pharmaceutically acceptable placebofor each of days 25 to 28.

Preferably, the daily dosage of each pharmaceutically active componentof the regimen remain fixed in each particular phase in which it isdelivered. It is further preferable that the daily dose units describedare to be delivered in the order described, with the first phasefollowed in order by the second and third phases. To help facilitatecompliance with each regimen, it is also preferred that the kits containthe placebo described for the final days of the cycle.

A number of packages or kits are known in the art for the use indispensing pharmaceutical agents for oral use. Preferably, the packagehas indicators for each day of the 28-day cycle, and more preferably isa labeled blister package, dial dispenser packages, or a bottle.

The following examples are provided to illustrate the invention and donot limit the scope thereof. One skilled in the art will appreciate thatalthough specific reagents and conditions are outlined in the followingexamples, modifications can be made which are meant to be encompassed bythe spirit and scope of the invention.

EXAMPLES Example 1 Breast Carcinoma Study

MCF-7 breast carcinoma cells are plated in 24-well dishes in phenol-redfree DMEM:F-12 (1:1) medium containing antibiotics, β-mercaptoethanol,ethanolamine, sodium selenite and 5% charcoal-stripped FCS. Thecompositions of the invention and vehicle are added the following dayand refreshed with media change every 48 hours. Cultures are stopped 9days later and proliferation assayed using the Cyquant kit (MolecularProbes, Eugene, Oreg.).

The results of this experiment illustrate the therapeutic effect thecompositions of the invention have on the treatment of breast carcinoma.

Example 2 Dysfunctional Uterine Bleeding Study

Thirty women are selected for the study. The women are randomly dividedinto two groups, one of which receives a regimen of the invention, andthe other of which receives a placebo. The patients are evaluated as tothe character of their dysfunctional uterine bleeding (blood loss,timing, etc.) prior to the study's initiation.

Women in the test group receive between 50-200 mg of the drug per day bythe oral route. This therapy continues for 6 months. Utility of thecompositions of the invention is illustrated by the therapeutic effectthey have on the patients' dysfunctional uterine bleeding.

Example 3 Anti-Androgenic Effect

The androgen receptor (AR) agonistic and antagonistic activity of thecompositions of the invention in the L929 cells which express the AR butnot the PR was evaluated as described in Zhang et al., Steroids,65(10-11): 637-643 (October-November 2000).

Cells were plated in 96-well plates at 25,000 cells/well in DMEM(BioWhittaker) with 10% (v/v) fetal bovine serum (FBS). The next day,cells were infected with the adenovirus PRE-tk-luciferase reporterconstruct (2×10⁹ pfu/ml particles) and kept in DMEM containing 10%charcoal stripped FBS for an additional 24 hours. Cells were thenseparately treated with a range of concentrations of thedihydrotestosterone (DHT) reference, the 2-hydroxyflutamide (2-OH-fluta)reference, or5′-(5-Cyano-1-methyl-1H-pyrrol-2-yl)spiro[cyclohexane-1,3′-[3H]indol]-2′-ylidenecyanamidediluted in the same medium. To test the anti-androgenic activity, cellswere co-treated with 3 nM DHT. Luciferase activity was measured 24 hoursfollowing the treatment. The following data were obtained:

TABLE 1 Compound IC50 (nM) 5′-(5-Cyano-1-methyl-1H-pyrrol-2-yl) 313spiro[cyclohexane-1,3′-[3H]indol]-2′-ylidenecyanamide 2-OH-fluta 49.9

From these data, it was noted that5′-(5-Cyano-1-methyl-1H-pyrrol-2-yl)spiro[cyclohexane-1,3′-[3H]indol]-2′-ylidenecyanamideshowed significant antagonistic activity over a nine point dose responseand only marginal agonistic activity at the maximum concentration tested(i.e., 10 nM).

All publications cited in this specification are incorporated herein byreference herein. While the invention has been described with referenceto a particularly preferred embodiment, it will be appreciated thatmodifications can be made without departing from the spirit of theinvention. Such modifications are intended to fall within the scope ofthe appended claims.

1. A method of providing hormone replacement therapy, said methodcomprising delivering to a female a composition comprising a compound offormula I, or a tautomer thereof, in a regimen which involves deliveringa pharmaceutically effective amount of one or more of a selectiveestrogen receptor modulator to said female, wherein formula I is:

wherein: R¹ and R² are joined to form —CH₂ CH₂ CH₂—; n is 3 or 4; R³ isH; R⁴ is H; R⁵ is a five or six membered heterocyclic ring having in itsbackbone 1 heteroatom selected from the group consisting of O, S, andNR⁶ and having one CN and one substituent selected from the groupconsisting of H, halogen, C₁ to C₄ alkyl, and CSR^(D); R^(D) is NH₂; R⁶is H, C₁ to C₃ alkyl or C₁ to C₄CO₂alkyl; Q¹ is S; or a pharmaceuticallyacceptable salt, tautomer, metabolite, or prodrug thereof; wherein saidselective estrogen receptor modulator is selected from the groupconsisting of EM-800, EM-652, raloxifene hydrochloride, arzoxifene,lasofoxifene, droloxifene, tamoxifen citrate, 4-hydroxytamoxifencitrate, clomiphene citrate, toremifene citrate, pipendoxifene,idoxifene, levormeloxifene, centchroman, nafoxidene, and bazedoxifene.2. The method according to claim 1, wherein said hormone replacementtherapy is perimenopausal, menopausal, or postmenopausal.
 3. The methodaccording to claim 1, wherein said compound is selected from the groupconsisting of4-(1′,2′-Dihydro-2′-thioxospiro[cyclohexane-1,3′-[3H]indol]-5′-yl)-2-thiophenecarbonitrile,5-(1,2-Dihydro-2-thioxospiro[cyclopentane-1,3-[3H]indol]-5′-yl)-1H-pyrrole-2-carbonitrile,5-(1,2-Dihydro-2-thioxospiro[cyclohexane-1,3-[3H]indol]-5-yl)-1-(tert-butoxycarbonyl)-pyrrole-2-carbonitrile,5-(1,2-Dihydro-2-thioxospiro[cyclohexane-1,3-[3H]indol]-5-yl)-1-H-pyrrole-2-carbonitrile,5-(2′-thioxospiro[cyclohexane-1,3′-[3H]indol]-5′-yl)-1-methyl-pyrrole-2-carbonitrile,5-(1,2-Dihydro-2-thioxospiro[cyclopentane-1,3-[3H]indol]-5-yl)-3-thiophenecarbonitrile,5-(1,2-Dihydro-thioxospiro[cyclopentane-1,3-[3H]indol]-5-yl)-2-thiophenecarbonitrile,5-(1,2-Dihydro-2-thioxospiro[cyclohexane-1,3-[3H]indol]-5-yl)-3-pyridinecarbonitrile,5-(1,2-Dihydro-2-thioxospiro[cyclohexane-1,3-[3H]indol]-5-yl)-3-furancarbonitrile,5-(1,2-Dihydro-2-thioxospiro[cyclohexane-1,3-[3H]indol]-5-yl)-4-propyl-2-thiophenecarbonitrile,4-(1,2-Dihydro-2-thioxospiro[cyclohexane-1,3-[3H]indol]-5-yl)-2-furancarbonitrile,5-(1″,2″-Dihydro-2″-thioxospiro[cyclohexane-1,3″-[3H]indol]-5″-yl)-4-methyl-2-thiophenecarbonitrile,5-(1″,2″-Dihydro-2″-thioxospiro[cyclohexane-1,3″-[3H]indol]-5″-yl)-2-thiophenecarbonitrile,and5-(1,2-Dihydro-2-thioxospiro[cyclohexane-1,3-[3H]indol]-5-yl)-4-n-butyl-2-thiophenecarbonitrile,or a pharmaceutically acceptable salt, tautomer, metabolite, or prodrugthereof.
 4. The method according to claim 1, wherein said compound offormula I and said selective estrogen receptor modulator are deliveredin a single composition.
 5. The method according to claim 1, whereinsaid compound of formula I and said selective estrogen receptormodulator are delivered separately.
 6. The method according to claim 1,wherein said compound is delivered at a daily dosage of about 0.1 toabout 50 mg.
 7. The method according to claim 1, wherein said regimencomprises delivering said composition daily for 1 to about 21 days,wherein said regimen is a cycle which is repeated monthly.
 8. The methodaccording to claim 1, wherein said selective estrogen receptor modulatoris delivered at a daily dosage of about 0.2 to about 100 mg.
 9. Themethod according to claim 1, wherein R⁵ is the five membered ring havingthe structure:

U is 0, S, or NR⁶; X′ is selected from the group consisting of halogen,CN, and CSNH₂; Y′ is H.
 10. The method according to claim 1, whereinsaid compound of formula (I) is5-(2′-thioxospiro[cyclohexane-1,3′-[3H]indol]-5′-yl)-1-methyl-pyrrole-2-carbonitrile.11. A method of providing hormone replacement therapy, said methodcomprising delivering to a female a composition comprising a compound offormula I, or a tautomer thereof, in a regimen which involves deliveringa pharmaceutically effective amount of one or more of a selectiveestrogen receptor modulator to said female, wherein formula I is:

wherein: R¹ and R² are joined to form —CH₂(CH₂)_(n)CH₂—, n is 3 or 4; R³is H; R⁴ is H; R⁵ is a five membered heterocyclic ring having in itsbackbone 1 NR⁶ heteroatom, one CN substituent, and one substituentselected from the group consisting of H, halogen, C₁ to C₄ alkyl, andCSR^(D); R^(D) is NH₂; R⁶ is H, C₁ to C₃ alkyl, or C₁ to C₄CO₂alkyl; Q¹is S; or a pharmaceutically acceptable salt, tautomer, metabolite, orprodrug thereof, wherein said selective estrogen receptor modulator isselected from the group consisting of EM-800, EM-652, raloxifenehydrochloride, arzoxifene, lasofoxifene, droloxifene, tamoxifen citrate,4-hydroxytamoxifen citrate, clomiphene citrate, toremifene citrate,pipendoxifene, idoxifene, levormeloxifene, centchroman, nafoxidene, andbazedoxifene.
 12. The method according to claim 11, wherein said hormonereplacement therapy is perimenopausal, menopausal, or postmenopausal.13. The method according to claim 11, wherein said compound is selectedfrom the group consisting of:5-(1′,2′-dihydro-2′-thioxospiro[cyclopentane-1′,3′-[3H]indol]-5′-yl)-1H-pyrrole-2-carbonitrile,5-(1′,2′-dihydro-2′-thioxospiro[cyclohexane-1′,3′-[3H]indol]-5′-yl)-1-(tert-butoxycarbonyl)-pyrrole-2-carbonitrile,5-(1′,2′-dihydro-2′-thioxospiro[cyclohexane-1′,3′-[3H]indol]-5′-yl)-1-H-pyrrole-2-carbonitrile,and5-(2′-thioxospiro[cyclohexane-1′,3′-[3H]indol]-5′-yl)-1-methyl-pyrrole-2-carbonitrile,or a pharmaceutically acceptable salt, tautomer, metabolite, or prodrugthereof.
 14. The method according to claim 11, wherein said compound offormula I and said selective estrogen receptor modulator are deliveredin a single composition.
 15. The method according to claim 11, whereinsaid compound of formula I and said selective estrogen receptormodulator are delivered separately.
 16. The method according to claim11, wherein said compound is delivered at a daily dosage of about 0.1 toabout 50 mg.
 17. The method according to claim 11, wherein said regimencomprises delivering said composition daily for 1 to about 21 days,wherein said regimen is a cycle which is repeated monthly.
 18. Themethod according to claim 11, wherein said selective estrogen receptormodulator is delivered at a daily dosage of about 0.2 to about 100 mg.19. The method according to claim 11, wherein R⁵ is the five memberedring having the structure:

X′ is CN; Y′ is H.